How to locate low-cost mental health care in the US and Canada (Guest Post!)

Thanks to Flickr user Mrs_Logic (no relation to the Commander), there is one photo of female mounties on the internet that does not involve a stripper costume!

Long-time reader The Mental Health Mountie has compiled some recommendations for affordable mental health care for us. Hopefully you will find it useful. If you’ve tried any of these methods and can tell us how it went or if you can suggest additional resources, let us know in the comments.

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Therapy on Sale

You’ve spoken to friends, you consulted the Internet, and you’ve thoroughly self-helped yourself. It’s more than you or your chums can handle. You’re being told by your mother/friend/partner/favorite advice columnist that it’s time to get yourself/your family/your child some therapy. It’s obvious that therapy is the next step, but you can’t spare the cash. Here are some suggestions to get yourself on that couch, on a budget.

1. If you are a student, you’re in luck. Colleges or universities may offer counseling services to students for free. You can contact the student services office for more information. If you are still a student, your parents’ insurance may even cover you for therapy outside your school. If you feel comfortable talking to your parents, you can ask them about their insurance. Some parents may even offer to help foot the bill.

2. If you want help for your child, schools have psychologists or counsellors who can work with kids, and this is a good place to start.

3. If you live near a college or university, many psychology or social work programs have “training clinics” where you can be seen for a low cost. This can be as low as $10 a session, with fees varying depending on income. Training clinics exist because budding psychologists and social workers need practice before going it alone. The therapy is supervised by licensed professionals, so your sessions will be discussed or taped to ensure you are getting competent treatment. The advantages: a) your therapist is probably putting a lot of time into understanding you and preparing for your sessions, b) the supervisor was likely chosen for their experience and knowledge, and c) two heads are better than one head, when working with your head. To pursue this option call the “clinical psychology” or “counseling psychology” or social work department and ask if they have a training clinic manned by students. You can also poke around on the university website. Here is an example from the University of Washington in Seattle: http://web.psych.washington.edu/psych.php#p=362

4. If you live near a hospital, call and ask if they have mental health clinics. Teaching hospitals may offer therapy for lower fees.

5. If you have a job, you may have an Employee Assistance Program (EAP) that offers short term counseling for free. Employers do prefer to nip mental health issues in the bud. The employed often forget about the EAP pamphlet that was stuffed into their orientation packet. If you have already recycled this pamphlet, call the Human Resources office to ask about the EAP program.

6. If you don’t mind cold calling, you can call community psychologists (make sure they are licensed) and ask them if they accept pro-bono clients. Also ask if they have a sliding scale, meaning, adjusted lower rates for low income clients. Psychologists are often nice and helpful people, and the best of them reserve slots for clients who cannot pay much. Some of my good friends who are psychologists offer slots like this. If these slots are full or non-existant, ask, “Can you refer me to another psychologist who may be able to help?” Once you have the psychologist on the phone, you might as well ask them about other low-cost services in the community. They have all the insider information and may be happy to share their knowledge.

7. If you are a member of a religious group or ethnic/linguistic community, or if you are LGBT, your group may want to help you. Community centers may offer low cost or free therapy services. What group defines you? Google your group + your area + “low cost therapy” and you may find some help. You can also call your local community centre for more information.

8. If you have a specific issue to work on, there may a community organization that can help or, at least, point you in the right direction. For example, there are organizations for people who have addictions, or who are victims of sexual or physical abuse. You can look for these groups online and by talking to people who have been through similar things. Call the group and ask about low cost therapy services. Psychologists or counsellors may work or volunteer for these groups. More general services may be offered by community agencies, like the YMCA.

9. If you don’t mind scientists, participate in a research study. This is an unconventional option, but there is a lot of research on therapy that happens for free. You may get treatment right away, or you may be put in a wait list control group, depending on the study. I have worked in numerous psychology research labs who offered free therapy funded by research grants. You may find therapy for depression, personality disorders, child behavior problems, addictions, martial problems, etc. Downsides include being asked to fill out many questionnaires. Upsides? You will get access to state-of-the-art therapies. And researchers who do these studies often compare established therapy methods to shiny new therapy methods. Both of these can be okay choices. The researchers are motivated to keep high quality control in their studies, so the care is often top notch. The downside is that it’s hard to find these services and calling your local psychology department can be a shot in the dark. One of my labs advertised on the radio and in community papers. Make sure the ad mentions an affiliation with a reputable educational institution.

11. If you are in Canada (as I am) or in other countries with public health care, many psychology services are free. Be aware of the sometimes ridiculously long wait lists. Ask your family doctor to explain the system to you, or explore the health department website for your province. Services may be offered in community clinics or hospitals. (My sympathies to all Americans and denizens of other countries who lack a public heath care system. I have seen clients from the US who needed to choose between food and mental health medication, which is unacceptable. I welcome you to immigrate to Canada, but the tradeoff is a really high tax rate).

12. If you feel lost or overwhelmed, calling a crisis line may be a good first step. Crisis line workers often have a huge binder listing service options in your area. And they may have a good amount of time to talk to you. When I volunteered at a crisis line, it was real quiet at 3 AM and I would have gladly spent a long time giving out helpful information from that humungous binder. Search for “crisis line” + your area. Or look on the NAMI website for numbers. If you feel you may be a danger to yourself, you can go to the nearest hospital emergency room.

13. Whenever you get any mental health people on the line (and they seem receptive), ask follow-up questions. They also may have a binder or a list with all sorts of helpful numbers.

14. If you have a friend or acquaintance who is a psych student or a psychologist/psychiatrist, they may be able to guide you. I get help-seeking emails and calls often, and I never mind pointing people in the right direction. I always keep the dialogue confidential.

A lot will depend on your location. Big urban centers have the most to offer in terms of low cost therapy services. Searching “low cost mental health” + a state/province or city name seems to work out well for Internet research. I did some light searching and, voila, tons of results.

This list may overwhelm you. You don’t have to pursue all these options. Just choose one per week. Eventually, you will get some leads. If you are too depressed to start, you can ask a friend or family member to do some research for you. You can start with a crisis line, as they are trained to be more directive.

For all of you seeking to be therapized, I wish that you find yourself in supportive hands very soon.

Thanks for all this, Mountie. It’s useful for us in the States even if we have insurance. Trying to find a therapist who took my (pretty good individual) insurance caused me to stick my head in the sand and ask my then-shrink for help. After a string of referral to referral to referral led to only no one who would accept my insurance or was taking new sliding scale patients, and the fact that my insurance is crap at timely repayment of out of network costs (over a year once) and I can’t afford $200 a week for therapy, just looking for a therapist was making me more crazy. I had a horrible experience with my first and otherwise only other therapist, which ironically made many therapists I called not want to take me on because they worried how I’d react if we weren’t a match (not sure if they were worried about me going further into depression or acting like the girl who tried to set her therapist on fire on “Wonderfalls”). My shrink gave me a number for a community clinic in town, and the woman I spoke to there asked me questions to help them match me with the best person. Already better than my insurance companies list of names based on my zip code. Fees are on a sliding scale, and since I’m unemployed I pay about, or even less, than I would as a co-pay. I could not love my therapist more. She listens to me, and catches those micro-expressions that show there is more going on in my head and asks me about it. She addresses any issues that come up about therapy, anything I might be hesitant about because of my experience with the bad therapist, or just because I am half British and half WASP and so find talking about emotions and needs very challenging.

Finding a therapist, or any medical practitioner, you like and click with can take a while. But you can find someone right for you even if you’re looking on the low end of the cost scale. My crap therapist had a fancy office in Beverly Hills, quit accepting my insurance and made me pay out of pocket after a year to make me “value” it more, then fired me as a patient after three and a half years because I “wasn’t making progress.” I will take my in training, community clinic current therapist over that any day. Made more progress with her in three months than I did in all that time with the awful one, too.

Another option: co-counseling or re-evaluation counseling. I’m not experienced enough in either to explain the difference, but basically both options involve (a) receiving a little low-cost training in how to give support (listening, asking non-judgmental questions) and (b) working in pairs or groups to give and receive support. There is some payment involved – I saw a week-long training class offered for $35, I’m not sure if that’s standard but I believe it’s part of the philosophy of this movement to keep it accessible.

I had a friend who did this for years in Philadelphia and found it very useful and supportive: she had help pulling off the layers of her buried troubles, but she also had the satisfaction of helping others and – very important – developed useful strategies for querying difficult or new feelings. I loved going to have a serious chat with her, because it was one probing non-judgmental question after another, and I felt that my troubles were really listened to and considered.